Stewardship in Action: How Two 2025 ASCP Champions Are Redesigning Test Utilization
By - March 20, 2026
Effective test utilization is a key piece in patient care and laboratory workflows, but it can be subject to frustrating inefficiencies. Good laboratory stewardship can help streamline testing processes and utilization, saving time, money, and improving care.
Two individuals made a notable impact on testing in their laboratories and were named 2025 ASCP Laboratory Stewardship Champions. They approached different problems in their respective health systems, yet both saw a common issue: important diagnostic tests were not being used as effectively as they could be. Here’s how they improved test utilization in their laboratories and the impact it has had.
What stewardship means today
Being named a 2025 ASCP Laboratory Stewardship Champion signals leadership in finding, tackling, and solving problems in laboratory testing. Daniel Mettman, MD, feels immensely grateful for the appreciation of and recognition for all the work done over the past few years by the numerous people involved in developing, incorporating, and maintaining this process. He is a pathologist on the Pathology and Laboratory Medicine Service at Kansas City VA Medical Center.
Josh Deignan, PhD, FACMG, sees being named a 2025 ASCP Laboratory Stewardship Champion as a “tremendous honor,” adding that “it represents all of the work that it took to push this initiative forward and see it to completion and beyond.” He is a professor and associate director of Molecular Diagnostics at the David Geffen School of Medicine at UCLA in the Department of Pathology and Laboratory Medicine.
While both see stewardship as important, their initiatives address distinct but equally complex challenges.
Noticing a testing gap
Dr. Mettman noticed that there was no process in place in the Kansas City VA’s electronic medical record (EMR) system for oncologists to concomitantly place orders for and initiate the dialogues necessary of certain esoteric molecular tests. This resulted in inefficiencies such as “three pathologists [being] notified about one request,” he says.
But inefficiency was only one issue; these tests often rely on archival tissue that may be irreplaceable, raising a greater need for stewardship. “If a biopsy sample is exhausted to perform an unnecessary test, then a patient may need to have a repeat biopsy with significant attendant risk or there may be a lack of tissue for a necessary test,” Dr. Mettman says.
Creating a consult-based solution
Dr. Mettman's solution required developing a consult process for these esoteric molecular tests; something he says was much more complex and time-consuming than he realized it would be.
The process involves clinical applications coordinators as well as information technology, medical records, coding, and management personnel. Previously unfamiliar with the intricacies of consults, he had to take a step-wise approach in order to become aware of the next task each step of the way. He credits the chief of his department, Dr. Sharad Mathur–who has been intimately involved in innumerable capacities throughout the local, regional, and national levels of the Veterans Healthcare Administration–with providing guidance and support. Without it, he wouldn't have known who to contact or which questions to ask.
“In addition to providing a mechanism for dialogue that is within the medical record and coincident with test request, consults result in a consult note. That note can function as a standardized place where clinicians can look for appended test report files and documentation of pathologist consultative work such that CPT codes can be billed and RVUs captured," he says.
Fewer duplicates, more actionable care
Dr. Mettman’s project is an example of how increased stewardship can have a strong impact on patient outcomes.
“Consult use has increased appropriate testing and decreased inappropriate testing, resulting in greater identification of actionable variants, increased use of targeted therapy, and higher clinical trial enrollment," he says.
Dr. Deignan: Redesigning inpatient genetic test ordering
At UCLA, Dr. Deignan confronted a different issue: inpatient genetic testing that was often delayed and duplicative.
“Genetic testing can be expensive, and when those tests are ordered on admitted patients, the test costs may end up being passed on to the health system,” Dr. Deignan says.
Tests ordered during a patient’s hospital stay weren’t always being used “to change any clinical management while the patient was admitted,” he says. And duplicate testing created provider confusion “if the scope and/or reporting approach used for the two tests is different.”
Engineering an eConsult gatekeeper model
Dr. Deignan’s solution took nearly a year of trial and error. After testing several models, including a program called “Second Sign,” the team developed a customized eConsult-based workflow:
Blocking certain inpatient genetic orders
Automatically notifying molecular laboratory leadership
Requiring an approval phrase before order release
He has been “constantly surprised by initially thinking that something is not possible and then later learning that there is a way to do that thing.” He stresses that anyone hoping to improve stewardship must be willing to “think outside the box.”
Reception, education and behavioral change
The clinician response to Dr. Deignan’s solution was “generally positively received, although there were definitely a few clinicians who had some early concerns,” he says.
In some cases, education was necessary to help people overcome the challenges associated with inpatient genetic testing.
“When providers aren’t initially able to place their order and are asked if they want to consult the lab, many decline the consultation option altogether.”
In other words, the pause itself promotes stewardship.
Improved timing and patient impact
Dr. Deignan’s initiative reduced unnecessary inpatient costs and improved timing of clinically relevant results.
“More of the approved orders appear to be finalized while those patients are still admitted, which is directly impacting their clinical management,” he says.
It also set precedents. “This was the first implementation of something that could sort of set the stage and make future genetic stewardship initiatives that much more palatable.”
Lessons for laboratories nationwide
There’s very little downside to improving lab testing stewardship, but Dr. Mettman makes clear that “It is going to be a slow progressive process… and it’s going to involve a lot of people.”
“Where there’s a will, there’s a way,” Dr. Mettman says.
Dr. Deignan echoes patience and stresses that it takes time to implement new ideas. “Socialization of new ideas is important.”
Their work makes clear that stewardship is an important framework for improving efficiency and delivering better patient care.
Jordan Rosenfeld
Contributing Writer
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